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Lim J, Dosis A, Lim M. A six-step approach to easy Endoloop ® application during laparoscopic appendicectomy. Ann R Coll Surg Engl 2024. [PMID: 38578034 DOI: 10.1308/rcsann.2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
- Jqi Lim
- York and Scarborough Teaching Hospitals NHS Foundation Trust, UK
| | - A Dosis
- The Leeds Teaching Hospitals NHS Trust, UK
| | - M Lim
- York and Scarborough Teaching Hospitals NHS Foundation Trust, UK
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Brainard J, Crawford A, Wright B, Lim M, Everden P. Retaining dermatology patients in primary care through dialogue with secondary care providers: A service evaluation. Ann Dermatol Venereol 2024; 151:103248. [PMID: 38513422 DOI: 10.1016/j.annder.2024.103248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/28/2023] [Accepted: 11/07/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND There are long patient waiting lists for specialist care. A dermatology dialogue service between primary and secondary care (DDPS) was developed in eastern England. Primary care referrers uploaded patient images of skin conditions for review by and dialogue with consultant dermatologists in an attempt to retain patients in primary care rather than refer them to secondary care. METHODS Evaluation of service performance against specific targets, including reduction in secondary care waiting list growth over the period April 2021-March 2022 inclusive. Service activity was summarized in terms of speed of resolution, case numbers, and dispositions. Clinician and patient satisfaction were assessed using structured questionnaires. Actual numbers of new referrals were compared to projections based on historical data. Waiting list growth was compared to other specialties and other commissioning areas. Waiting times to initial treatment were monitored. RESULTS Over 3300 patients were enrolled and > 90% of dialogues were resolved within 36 hours. Clinician and patient satisfaction were high. Frequently asked questions and conditions were highlighted by dermatologists to design and deliver an educational event for primary care clinicians that was well received. Waiting list growth for dermatology patients in the commissioning area was smaller than for other major specialties, and generally smaller than growth for dermatology waiting lists commissioned by other NHS commissioners. There was no negative impact on the urgent priority (cancer pathway) waiting list. CONCLUSION The DDPS was satisfactory for clinicians and patients and coincided with lower growth in dermatology waiting lists than might otherwise have been expected.
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Affiliation(s)
- J Brainard
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
| | - A Crawford
- North Norfolk Primary Care, 4 Alkmaar Way, Norwich NR6 6BF, United Kingdom
| | - B Wright
- North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, United Kingdom
| | - M Lim
- Norfolk and Waveney Integrated Care Board, County Hall, Martineau Lane, Norwich NR1 2DL, United Kingdom
| | - P Everden
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom; North Norfolk Primary Care, 4 Alkmaar Way, Norwich NR6 6BF, United Kingdom
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Jayaram L, King PT, Hunt J, Lim M, Park C, Hu E, Dousha L, Ha P, Bartlett JB, Southcott AM, Muruganandan S, Vogrin S, Rees MA, Dean OM, Wong CA. Evaluation of high dose N- Acetylcysteine on airway inflammation and quality of life outcomes in adults with bronchiectasis: A randomised placebo-controlled pilot study. Pulm Pharmacol Ther 2024; 84:102283. [PMID: 38141851 DOI: 10.1016/j.pupt.2023.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND High dose N acetylcysteine (NAC), a mucolytic, anti-inflammatory and antioxidant agent has been shown to significantly reduce exacerbations, and improve quality of life in placebo controlled, double blind randomised (RCT) studies in patients with COPD, and in an open, randomised study in bronchiectasis. In this pilot, randomised, double-blind, placebo-controlled study, we wished to investigate the feasibility of a larger clinical trial, and the anti-inflammatory and clinical benefits of high dose NAC in bronchiectasis. AIMS Primary outcome: to assess the efficacy of NAC 2400 mg/day at 6 weeks on sputum neutrophil elastase (NE), a surrogate marker for exacerbations. Secondary aims included assessing the efficacy of NAC on sputum MUC5B, IL-8, lung function, quality of life, and adverse effects. METHODS Participants were randomised to receive 2400 mg or placebo for 6 weeks. They underwent 3 visits: at baseline, week 3 and week 6 where clinical and sputum measurements were assessed. RESULTS The study was stopped early due to the COVID pandemic. In total 24/30 patients were recruited, of which 17 completed all aspects of the study. Given this, a per protocol analysis was undertaken: NAC (n = 9) vs placebo (n = 8): mean age 72 vs 62 years; male gender: 44% vs 50%; baseline median FEV11.56 L (mean 71.5 % predicted) vs 2.29L (mean 82.2% predicted). At 6 weeks, sputum NE fell by 47% in the NAC group relative to placebo (mean fold difference (95%CI: 0.53 (0.12,2.42); MUC5B increased by 48% with NAC compared with placebo. Lung function, FVC improved significantly with NAC compared with placebo at 6 weeks (mean fold difference (95%CI): 1.10 (1.00, 1.20), p = 0.045. Bronchiectasis Quality of life measures within the respiratory and social functioning domains demonstrated clinically meaningful improvements, with social functioning reaching statistical significance. Adverse effects were similar in both groups. CONCLUSION High dose NAC exhibits anti-inflammatory benefits, and improvements in aspects of quality of life and lung function measures. It is safe and well tolerated. Further larger placebo controlled RCT's are now warranted examining its role in reducing exacerbations.
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Affiliation(s)
- L Jayaram
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia.
| | - P T King
- Monash Medical Centre, Clayton Road, Clayton, VIC, 3068, Australia; Monash University, Wellington Road, Clayton, VIC, 3068, Australia
| | - J Hunt
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - M Lim
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - C Park
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - E Hu
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - L Dousha
- Monash Medical Centre, Clayton Road, Clayton, VIC, 3068, Australia; Monash University, Wellington Road, Clayton, VIC, 3068, Australia
| | - P Ha
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia
| | - J B Bartlett
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia
| | - A M Southcott
- Western Health, Gordon Street, Footscray, VIC, 3011, Australia; University of Melbourne, Parkville, VIC, 3010, Australia
| | - S Muruganandan
- University of Melbourne, Parkville, VIC, 3010, Australia; Northern Health, Epping, VIC, 3076 Australia
| | - S Vogrin
- University of Melbourne, Parkville, VIC, 3010, Australia
| | - M A Rees
- University of Melbourne, Parkville, VIC, 3010, Australia; Royal Melbourne Hospital, Gratten St, VIC, 3050, Australia
| | - O M Dean
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, 3220 Australia; Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, VIC , 3010, Australia
| | - C A Wong
- Middlemore Hospital, Te Whatu Ora, Otahuhu, Auckland, 1025, New Zealand; University of Auckland, Park Road, Auckland, 1010, New Zealand
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Lim M, Archambeaud A, Ferreira-Maldent N, Cottier JP, Samimi M. Pseudotumoral presentation of neuro-Behçet's disease in a patient receiving apremilast: A precipitating agent? Ann Dermatol Venereol 2024; 151:103251. [PMID: 38417200 DOI: 10.1016/j.annder.2024.103251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/31/2023] [Accepted: 01/08/2024] [Indexed: 03/01/2024]
Affiliation(s)
- M Lim
- Department of Dermatology, University Hospital Center of Tours, Tours, France
| | - A Archambeaud
- Department of Internal Medicine, University Hospital Center of Tours, Tours, France
| | - N Ferreira-Maldent
- Department of Internal Medicine, University Hospital Center of Tours, Tours, France
| | - J-P Cottier
- Department of Neuroradiology, University Hospital Center of Tours, Tours, France
| | - M Samimi
- Department of Dermatology, University Hospital Center of Tours, Tours, France.
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Ambach A, Celo K, Lim M, Marbach J, Tikekar Z, Gonzalez RJ. Effect of water calcium, copper, and silver on branchial Na + permeability in a characid and cichlid fish. Comp Biochem Physiol A Mol Integr Physiol 2024; 288:111553. [PMID: 37956900 DOI: 10.1016/j.cbpa.2023.111553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Abstract
We tested the hypothesis that water Ca2+ is involved in control of branchial Na+ permeability in low pH tolerant convict cichlids and black neon tetras. We measured Na+ efflux in water with different Ca2+ concentrations during exposure to low pH, silver, and copper, at levels which are known to stimulate Na+ efflux. For convict cichlids at pH 7.5 exposure to 0 μmol L-1 Ca2+caused Na+ efflux to rise 2.5 times above controls at 100 μmol L-1 Ca2+. However, raising [Ca2+] to 500 μmol L-1 had no effect. Upon exposure to pH 3.5 (control [Ca2+]) Na+ efflux rose almost 5× and increasing the [Ca2+] 5-fold did not reduce the magnitude of stimulation. Exposure to 1 μmol L-1 silver and 25 μmol L-1 copper stimulated Na+ efflux 7×, and 2×, respectively. Raising [Ca2+] concentration during metal exposure halved the stimulation of Na+ efflux caused by silver, and eliminated the stimulation elicited by copper. For black neon tetras raising or lowering water [Ca2+] had no effect on Na+ efflux at pH 7.5. Exposure to pH 3.5 caused Na+ efflux to rise 2.5× but changing [Ca2+] had no effect. Exposure to 1 μmol L-1 silver, or 25 μmol L-1 copper caused Na+ efflux of tetras to rise 4-fold and 3-fold, respectively. Raising [Ca2+] during silver exposure reduced the stimulation of Na+ efflux by about 50%, but during copper exposure increased [Ca2+] had no effect on stimulation of Na+ efflux. These results suggest water Ca2+ plays a role in control of branchial Na+ permeability in cichlids, but perhaps not tetras. In addition, the silver and copper concentrations required to inhibit Na+ uptake and stimulate Na+ efflux were higher than the concentrations used on non-characids and non-cichlids, which indicates that our fish are much more tolerant of these metals.
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Affiliation(s)
- A Ambach
- Department of Biology, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - K Celo
- Department of Biology, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - M Lim
- Department of Biology, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - J Marbach
- Department of Biology, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Z Tikekar
- Department of Biology, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - R J Gonzalez
- Department of Biology, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA.
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Tavasolian F, Lively S, Pastrello C, Tang M, Lim M, Pacheco A, Qaiyum Z, Yau E, Baskurt Z, Jurisica I, Kapoor M, Inman RD. Proteomic and genomic profiling of plasma exosomes from patients with ankylosing spondylitis. Ann Rheum Dis 2023; 82:1429-1443. [PMID: 37532285 DOI: 10.1136/ard-2022-223791] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Recent advances in understanding the biology of ankylosing spondylitis (AS) using innovative genomic and proteomic approaches offer the opportunity to address current challenges in AS diagnosis and management. Altered expression of genes, microRNAs (miRNAs) or proteins may contribute to immune dysregulation and may play a significant role in the onset and persistence of inflammation in AS. The ability of exosomes to transport miRNAs across cells and alter the phenotype of recipient cells has implicated exosomes in perpetuating inflammation in AS. This study reports the first proteomic and miRNA profiling of plasma-derived exosomes in AS using comprehensive computational biology analysis. METHODS Plasma samples from patients with AS and healthy controls (HC) were isolated via ultracentrifugation and subjected to extracellular vesicle flow cytometry analysis to characterise exosome surface markers by a multiplex immunocapture assay. Cytokine profiling of plasma-derived exosomes and cell culture supernatants was performed. Next-generation sequencing was used to identify miRNA populations in exosomes enriched from plasma fractions. CD4+ T cells were sorted, and the frequency and proliferation of CD4+ T-cell subsets were analysed after treatment with AS-exosomes using flow cytometry. RESULTS The expression of exosome marker proteins CD63 and CD81 was elevated in the patients with AS compared with HC (q<0.05). Cytokine profiling in plasma-derived AS-exosomes demonstrated downregulation of interleukin (IL)-8 and IL-10 (q<0.05). AS-exosomes cocultured with HC CD4+ T cells induced significant upregulation of IFNα2 and IL-33 (q<0.05). Exosomes from patients with AS inhibited the proliferation of regulatory T cells (Treg), suggesting a mechanism for chronically activated T cells in this disease. Culture of CD4+ T cells from healthy individuals in the presence of AS-exosomes reduced the proliferation of FOXP3+ Treg cells and decreased the frequency of FOXP3+IRF4+ Treg cells. miRNA sequencing identified 24 differentially expressed miRNAs found in circulating exosomes of patients with AS compared with HC; 22 of which were upregulated and 2 were downregulated. CONCLUSIONS Individuals with AS have different immunological and genetic profiles, as determined by evaluating the exosomes of these patients. The inhibitory effect of exosomes on Treg in AS suggests a mechanism contributing to chronically activated T cells in this disease.
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Affiliation(s)
- Fataneh Tavasolian
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Starlee Lively
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Chiara Pastrello
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, - Data Science Discovery Centre for Chronic Diseases, University Health Network, Toronto, Ontario, Canada
| | - Michael Tang
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Melissa Lim
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Addison Pacheco
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Zoya Qaiyum
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Enoch Yau
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Zeynep Baskurt
- Department of Biostatistics, Princess Margaret Cancer Center, 610 University Ave, Toronto, Ontario, Canada
| | - Igor Jurisica
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, - Data Science Discovery Centre for Chronic Diseases, University Health Network, Toronto, Ontario, Canada
- Departments of Medical Biophysics and Computer Science, and Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Mohit Kapoor
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Division of Orthopaedic Surgery and Department of Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Robert D Inman
- Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Spondylitis Program, Division of Rheumatology, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
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Bhatia R, Mai A, George J, Cao Y, Siu C, Lee EE, Redmond KJ, Jackson C, Lim M, Bettegowda C, Kleinberg LR. Outcomes of Brain Metastases with Suspicious Imaging Undergoing Resection to Evaluate for Radionecrosis vs. Tumor Progression. Int J Radiat Oncol Biol Phys 2023; 117:e88. [PMID: 37786204 DOI: 10.1016/j.ijrobp.2023.06.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In patients treated with stereotactic radiosurgery (SRS) for brain metastases, radiographic changes on surveillance imaging may result from treatment effect/radionecrosis (RN) or tumor progression. Distinguishing between these processes is critical to appropriate management. We report long-term outcomes for a cohort of patients who demonstrated radiographic progression on serial imaging after initial radiation and ultimately underwent resection to inform further management. MATERIALS/METHODS A retrospective chart review identified 76 patients with an associated 82 brain lesions between 2009 and 2022 that were initially treated with SRS, then demonstrated suspicious imaging changes developing through at least two scan time points that led to pathologic confirmation of either tumor or RN. We report clinical outcomes and details of further treatments. RESULTS Of the 82 lesions, 55 (67.1%) were found to be pathologically-confirmed viable tumor and were treated with repeat radiation and 27 (32.9%) were found to be strictly RN and conservatively managed. Over half of the lesions (14/27) ultimately found to be radionecrotic required use of steroids pre-operatively due to neurologic symptoms. Among the 27 that were found to be RN, the most common histology was melanoma (33.3%, n = 9). The most common dose fractionation regimen was 20 Gy in 1 fx (n = 11, 40.7%; range: 16-20 Gy x 1Fx), and the median BED (10) was 50.4 Gy (IQR 41.6 - 50 Gy). None of these lesions required further intervention with median post-surgery follow up of 24.4 months (range 1-104 months). There were 55 instances (in 51 patients) of pathologically-confirmed recurrent/progressive tumor who were consequently treated with repeat radiation with either Cs-131 brachytherapy (12 (21.8%)) or SRS (43 (78.2%)). The most common histology was NSCLC (37.2%, n = 19). The most common fractionation for repeat irradiation with SRS was 8 Gy x 3 fx (n = 15, 27.3%), followed by 5 Gy x 5 fx (n = 10, 18.2%), and 4 Gy x 5 fx (n = 8, 14.6%). Four individuals each had two lesions that were re-irradiated for local recurrence. Among patients treated with re-irradiation, the median follow-up to local failure was 15.2 months (95% CI 7.3-26.6 months). Radionecrosis was confirmed on pathology in 4/55 (7.2%) of lesions. The median follow-up from date of SRS2 to local failure was 14.1 months (95% CI 7.6-24.3 months). The 2-yr local control rate was 74.8% (95% CI 61.7-90.7%). CONCLUSION We recommend cautious monitoring of possible progression after radiosurgery, with consideration of resection for continuous progression, as a significant proportion of radiographic progression are ultimately pure RN. Management determined by pathology (observation for RN; additional radiation for confirmed tumor) leads to excellent control.
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Affiliation(s)
- R Bhatia
- Johns Hopkins University, Baltimore, MD
| | - A Mai
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J George
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA
| | - Y Cao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Siu
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - E E Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - K J Redmond
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Jackson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Lim
- Department of Neurosurgery, Stanford University, Stanford, CA
| | - C Bettegowda
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - L R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Chong C, de Leon J, Tan H, Crawford D, Jameson M, Hogan L, Pagulayan C, Jelen U, Biggerstaff K, Chhabra A, Twentyman T, Rahim K, Leong E, Lim M, Batumalai V. MRI Guided Adaptive Radiotherapy (MRgART) in Primary and Metastatic Liver Lesions. Int J Radiat Oncol Biol Phys 2023; 117:e288-e289. [PMID: 37785067 DOI: 10.1016/j.ijrobp.2023.06.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The role of stereotactic body radiotherapy (SBRT) in the management of primary hepatic and metastatic tumors has increased significantly over the past few years. MR-Linac is rapidly gaining evidence in the delivery of ablative doses using MR guided adaptive radiotherapy (MRgART) with improved accuracy and dose coverage to the lesions. We report local control and toxicity of patients with primary and metastatic liver lesions treated with MR guided adaptive SBRT. MATERIALS/METHODS All patients were treated with MRgART on the Unity 1.5T MR Linacs at two institutions and consented to the ADAPT-MRL study (1). A 4DCT and MRI with abdominal compression were obtained at simulation and the primary MRI sequence used for online treatment included a T2 3D navigated scan. A balanced turbo field echo (btFFE) 2D cine motion scan was also acquired at every fraction to determine movement of the tumor to aid in internal target volume margin. All plans were treated with SBRT prescribed to 3-5 alternate daily fractions. Acute toxicity was reported according to Common Terminology Criteria for Adverse Events version 5 (CTCAE) v.5. Patient demographics, prescribed dose fractionation, acute toxicity and clinical response at 6 months were analyzed. Clinical response to treatment was measured according to RECIST criteria 1.1. RESULTS Between February 2021 to January 2023 a total of 30 patients were treated with 149 fractions to the liver. Patients were majority male (70%) with a median age of 66 (range 36-83). 16 patients were treated for primary hepatocellular carcinoma (HCC) of the liver and 14 patients for metastatic liver lesions. The median prescribed dose was 48 Gy (range 30-50Gy) in median 5 fractions (range (3-5 fractions). All patients completed treatment with no interruptions. The mean time from 'patient setup' to 'beam-off' was 52.6 minutes (range 37-73 minutes). Data on acute toxicity at 3 month follow up was available for 28 patients. Of these patients 7/28 (25%) had grade 1 or 2 toxicity and no >/ = grade 3 toxicity was reported. Clinical response at 6 months was available for 18 patients and showed complete response in 44% (8/18), partial response in 22% (4/18), stable disease in 22% (4/18) and progressive disease in 11.1% (2/18). CONCLUSION Our experience on MRgART to the liver has shown good local control and minimal acute toxicity in the treatment of primary and metastatic liver lesions. We continue to collect data on patient reported outcomes, clinical response and toxicity to determine the feasibility and safety of this system.
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Affiliation(s)
- C Chong
- GenesisCare Murdoch, Perth, Western Australia, Australia
| | - J de Leon
- GenesisCare St. Vincent's Clinic, Sydney, NSW, Australia
| | - H Tan
- GenesisCare Murdoch, Perth, Western Australia, Australia; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - D Crawford
- GenesisCare St. Vincent's Clinic, Sydney, NSW, Australia
| | - M Jameson
- GenesisCare St. Vincent's Clinic, Sydney, NSW, Australia
| | - L Hogan
- GenesisCare Murdoch, Perth, Western Australia, Australia
| | - C Pagulayan
- GenesisCare St. Vincent's Clinic, Sydney, NSW, Australia
| | - U Jelen
- GenesisCare St. Vincent's Clinic, Sydney, NSW, Australia
| | - K Biggerstaff
- GenesisCare Murdoch, Perth, Western Australia, Australia
| | - A Chhabra
- GenesisCare Murdoch, Perth, Western Australia, Australia
| | - T Twentyman
- GenesisCare St. Vincent's Clinic, Sydney, NSW, Australia
| | - K Rahim
- GenesisCare Murdoch, Perth, Western Australia, Australia; Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - E Leong
- GenesisCare Murdoch, Perth, Western Australia, Australia; Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - M Lim
- GenesisCare Murdoch, Perth, Western Australia, Australia
| | - V Batumalai
- GenesisCare St. Vincent's Clinic, Sydney, NSW, Australia
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Walters P, Mody K, Stewart S, Silva C, Lim M, Landers D, Dudiy Y, Elmann E, Ng A, Batsides G, Anderson M. Early Upgrade to Impella 5.5 Improves Survival in Acute Coronary Syndrome Complicated by Cardiogenic Shock. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Mody K, Batsides G, Stewart S, Walters P, Silva C, Dudiy Y, Elmann E, Ng A, Landers D, Vaidya P, Lim M, Anderson M. Native Heart Recovery after Left Ventricular Unloading with the Impella 5.5 in Patients with Cardiogenic Shock. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Emerson LM, Pellicano E, Monk R, Lim M, Heaton J, McLay L. A portfolio analysis of autism research funding in Aotearoa New Zealand 2007-2021. Autism 2023; 27:13623613231155954. [PMID: 36802870 PMCID: PMC10576894 DOI: 10.1177/13623613231155954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
LAY ABSTRACT We aimed to document the areas of autism research that have previously been funded in Aotearoa New Zealand. We searched for research grants awarded to autism research in Aotearoa New Zealand between 2007 and 2021. We compared the funding distribution in Aotearoa New Zealand to other countries. We asked people from the autistic community and broader autism community whether they were satisfied with this funding pattern, and whether it aligned with what is important to them and to autistic people. We found that the majority of funding for autism research was awarded to biology research (67%). Members of the autistic and autism communities were dissatisfied with the funding distribution, and expressed a lack of alignment with what is important to them. People from the community indicated that the funding distribution did not address the priorities of autistic people, and that it indicated a lack of engagement with autistic people. Autism research funding needs to reflect the priorities of the autistic and autism communities. Autistic people need to be included in autism research and related funding decisions.
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Affiliation(s)
| | | | - Ruth Monk
- University of Canterbury, New Zealand
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12
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Sloan L, Sen R, Hu C, Liu C, Doucet M, Blosser L, Thompson E, Katulis L, Kamson D, Grossman S, Holdhoff M, Redmond K, Quon H, Lim M, Eberhart C, Pardoll D, Ganguly S, Kleinberg L. Radiation Immunodynamics as the Foundation of Immune-Guided Radiotherapy: Changes in Peripheral CD14+PD-L1+ Myeloid Cells over the Course of Chemoradiation and Association with Survival for New Diagnosis of Glioblastoma. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Bhatia R, George J, Siu C, Baker B, Lee E, Redmond K, Jackson C, Bettegowda C, Lim M, Kleinberg L. Outcomes of Brain Metastases Managed with Resection and Aggressive Reirradiation after Initial Radiosurgery Failure. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Hochberg J, Xavier A, Audino A, Barth M, Miles R, Kahwash S, Voss S, Braniecki S, Moorthy C, Armenian S, Ehrhardt M, Lim M, Harrison L, Goldman S, Cairo M. REDUCING THE BURDEN OF ONCOLOGY CHEMORADIOTHERAPY AND RADIATION EXPOSURE FROM DIAGNOSTIC IMAGING BY UTILIZING TARGETED IMMUNOTHERAPY IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS WITH LYMPHOMA (RADICAL, HODGKIN LYMPHOMA COHORT. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00209-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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15
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Lim M, Lee C, Chan A. Correlation between endometrial age and blastocyst age: Implantation and Pregnancy Rates with Euploid FET. Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2022]
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16
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Audino A, Xavier A, Hochberg J, Barth M, Miles R, Kahwash S, Voss S, Braniecki S, Moorthy C, Armenian S, Ehrhardt M, Lim M, Harrison L, Goldman S, Cairo M. REDUCING CHEMORADIOTHERAPY AND RADIATION EXPOSURE FROM DIAGNOSTIC IMAGING BY UTILIZING TARGED IMMUNOTHERAPY IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS (CAYA) WITH MATURE LARGE B-CELL LYMPHOMA (RADICAL). Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00250-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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17
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Weller M, Ellingson B, Alexander B, Wen P, Sulman E, Colman H, Berry D, Tanner K, Khasraw M, Lim M, Perry J, Lassman A, Cloughesy T, Yung WKA, Lee EQ, Mellinghoff I, Gordon G, de Groot J, Mikkelsen T, Cavenee W, Nelli A, Buxton M, Li W. P11.65.B GBM AGILE: A global, phase 2/3 adaptive platform trial to evaluate multiple treatment regimens in newly diagnosed and recurrent glioblastoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
GBM AGILE (Glioblastoma Adaptive, Global, Innovative Learning Environment) is a biomarker based, multi-arm, international, seamless Phase 2/3 Response Adaptive Randomization platform trial designed to rapidly identify experimental therapies that improve overall survival and confirm efficacious experimental therapies and associated biomarker signatures to support new drug approvals and registration. It is a collaboration between academic investigators, patient organizations and industry, under the sponsorship of the non-profit organization, Global Coalition for Adaptive Research, to support new drug applications for newly diagnosed and recurrent GBM.
Material and Methods
The primary objective of GBM AGILE is to identify therapies that effectively improve overall survival in patients with newly diagnosed or recurrent GBM. Bayesian response adaptive randomization is used within subtypes of the disease to assign participants to investigational arms based on their performance. Operating under a master protocol, GBM AGILE allows multiple drugs from different pharmaceutical companies to be evaluated simultaneously and/or over time against a common control arm. Based on performance, a drug may graduate and move to a Stage 2 (Phase 3) within the trial, and the totality of the data can be used for a new drug application and registration process. New experimental therapies are added as information about promising new drugs is identified while other therapies are removed as they complete their evaluation. The master protocol/ trial infrastructure includes efficiencies through an adaptive trial design, shared control arm and operational processes such as risk-based monitoring and enhanced remote activities. With its adaptable structure, GBM AGILE has continued trial activation, inclusion of new investigational therapies, and enrollment globally through the challenges of a global pandemic.GBM AGILE provides an efficient mechanism to screen and develop robust information regarding the efficacy of proposed novel therapeutics and associated biomarkers for GBM and to quickly move therapies and biomarkers into clinic. GBM AGILE received initial approval from the United States FDA in April 2019, and in Europe through the Voluntary Harmonization Procedure (VHP) in April, 2021. As of 2022, AGILE has screened over 1000 patients studying multiple investigational treatments. Enrollment rates are 3 to 4 times greater than traditional GBM trials, with active sites averaging 0.75 to 1 patients/site/month.
Currently, there are 41 sites activated in the US, 4 in Canada and 2 in Switzerland and an estimated 24 sites yet to open in Germany, France, Switzerland, Italy and Austria. In addition to the continued expansion in Europe, effort is undergoing to extend the trial to China and Australia as well. Clinical trial information: NCT03970447
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Affiliation(s)
- M Weller
- Universitätsspital Zürich , Klinik für Neurologie, Zürich , Switzerland
| | - B Ellingson
- University of California , Los Angeles, CA , United States
| | - B Alexander
- Dana Farber Cancer Institute, Harvard University , Boston, MA , United States
| | - P Wen
- Dana Farber Cancer Institute , Boston, MA , United States
| | - E Sulman
- NYU Grossman School of Medicine , New York, NY , United States
| | - H Colman
- University of Utah, Salt Lake City, UT , United States
| | - D Berry
- Berry Consultants , Austin, TX , United States
| | - K Tanner
- National Brain Tumor Society , Newton, MA , United States
| | - M Khasraw
- Duke Cancer Institute, Duke University , Durham, NC , United States
| | - M Lim
- Stanford University , Stanford, CA , United States
| | - J Perry
- University of Toronto, Toronto , ON , Canada
| | - A Lassman
- Columbia University, New York City, NY , United States
| | - T Cloughesy
- University of California Los Angeles , Los Angeles, CA , United States
| | - W K A Yung
- UT MD Anderson Cancer Center , Houston, TX , United States
| | - E Q Lee
- Dana Farber Cancer Institute , Boston, MA , United States
| | - I Mellinghoff
- Memorial Sloan Kettering, New York City, NY , United States
| | - G Gordon
- Global Coalition for Adaptive Research , Larkspur, CA , United States
| | - J de Groot
- University of California, San Francisco , San Francisco, CA , United States
| | - T Mikkelsen
- Henry Ford Health , Detroit, MI , United States
| | - W Cavenee
- University of California San Diego , La Jolla, CA , United States
| | - A Nelli
- Global Coalition for Adaptive Research , Larkspur, CA , United States
| | - M Buxton
- Global Coalition for Adaptive Research , Larkspur, CA , United States
| | - W Li
- Beijing Tiantan Hospital, Capital Medical University , Beijing , China
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18
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Bin Eid W, Lim M, Halstead E, Esposito G, Dimitriou D. A cross-cultural comparison of sleep patterns between typically developing children and children with ASD living in Saudi Arabia and the United Kingdom. Res Dev Disabil 2022; 128:104290. [PMID: 35810543 DOI: 10.1016/j.ridd.2022.104290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/10/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Sleep is crucial for child development, especially for children with ASD. While it is known that children with ASD experience more severe sleep problems and that these problems tend to persist compared to their typically developing counterparts, these findings tend to come from only Western countries. A cross-cultural study is important to understand if the prevailing understanding of sleep in children with ASD can be extended to different cultural backgrounds. AIM A cross-cultural study is conducted, involving typically developing children and children with ASD aged 5-12 across two countries: Saudi Arabia and the United Kingdom. METHODS AND PROCEDURES Using a combination of questionnaires measuring ASD severity (CARS-2), sleep quality (CSHQ), sociodemographic and lifestyle variables and sleep diaries, 244 children were sampled using a mixture of snowball and convenience sampling methods. OUTCOMES AND RESULTS Children with ASD experience more sleep problems compared to typically developing children in Saudi Arabia, and these problems similarly persist across time. Specifically, it was found that children with ASD in Saudi Arabia experience greater sleep onset latency and a greater number of night awakenings. Additionally, across the ASD groups, it was found that children from Saudi Arabia generally experienced poorer sleep than children in the United Kingdom in terms of shorter sleep duration, although children in the United Kingdom tended to report more instances of sleep anxiety and parasomnias. CONCLUSIONS AND IMPLICATIONS Several reasons such as parental education about sleep hygiene, cultural influences and social hours were put forward as potential explanations for cross-cultural differences. Findings served to emphasise the importance of culturally-appropriate interventions and public education regarding child sleep.
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Affiliation(s)
- W Bin Eid
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, WC1H 0AA London, UK
| | - M Lim
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore
| | - E Halstead
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, WC1H 0AA London, UK
| | - G Esposito
- Affiliative Behaviour and Physiology Lab, Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 31, I-38068 Rovereto, Italy.
| | - D Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, WC1H 0AA London, UK.
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19
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Matsumoto Y, Dimitriou ID, La Rose J, Lim M, Camilleri S, Law N, Adissu HA, Tong J, Moran MF, Chruscinski A, He F, Asano Y, Katsuyama T, Sada KE, Wada J, Rottapel R. Tankyrase represses autoinflammation through the attenuation of TLR2 signaling. J Clin Invest 2022; 132:140869. [PMID: 35362478 PMCID: PMC8970677 DOI: 10.1172/jci140869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Dysregulation of Toll-like receptor (TLR) signaling contributes to the pathogenesis of autoimmune diseases. Here, we provide genetic evidence that tankyrase, a member of the poly(ADP-ribose) polymerase (PARP) family, negatively regulates TLR2 signaling. We show that mice lacking tankyrase in myeloid cells developed severe systemic inflammation with high serum inflammatory cytokine levels. We provide mechanistic evidence that tankyrase deficiency resulted in tyrosine phosphorylation and activation of TLR2 and show that phosphorylation of tyrosine 647 within the TIR domain by SRC and SYK kinases was critical for TLR2 stabilization and signaling. Last, we show that the elevated cytokine production and inflammation observed in mice lacking tankyrase in myeloid cells were dependent on the adaptor protein 3BP2, which is required for SRC and SYK activation. These data demonstrate that tankyrase provides a checkpoint on the TLR-mediated innate immune response.
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Affiliation(s)
- Yoshinori Matsumoto
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ioannis D Dimitriou
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jose La Rose
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Lim
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susan Camilleri
- Centre for Modeling Human Disease, Toronto Centre for Phenogenomics, Toronto, Ontario, Canada
| | - Napoleon Law
- Centre for Modeling Human Disease, Toronto Centre for Phenogenomics, Toronto, Ontario, Canada
| | - Hibret A Adissu
- Labcorp Early Development Laboratories Inc., Chantilly, Virginia, USA
| | - Jiefei Tong
- Program in Cell Biology, The Hospital for Sick Children, Department of Molecular Genetics
| | - Michael F Moran
- Program in Cell Biology, The Hospital for Sick Children, Department of Molecular Genetics
| | | | - Fang He
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Asano
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Katsuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Robert Rottapel
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine.,Department of Medical Biophysics, and.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Division of Rheumatology, St. Michael's Hospital, Toronto, Ontario, Canada
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20
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Sims HS, de Andrade Horn P, Isshiki R, Lim M, Xu Y, Grubbs RH, Dai M. Catalysis-Enabled Concise and Stereoselective Total Synthesis of the Tricyclic Prostaglandin D 2 Metabolite Methyl Ester. Angew Chem Int Ed Engl 2022; 61:e202115633. [PMID: 34870881 PMCID: PMC8766936 DOI: 10.1002/anie.202115633] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Indexed: 01/28/2023]
Abstract
A concise and stereoselective total synthesis of the clinically relevant tricyclic prostaglandin D2 metabolite (tricyclic-PGDM) methyl ester in racemic form was accomplished in eight steps from a readily available known cyclopentene-diol derivative. The synthesis features a nickel-catalyzed Ueno-Stork-type dicarbofunctionalization to generate two consecutive stereocenters, a palladium-catalyzed carbonylative spirolactonization to build the core oxaspirolactone, and a Z-selective cross-metathesis to introduce the (Z)-3-butenoate side chain, a group challenging to introduce through traditional Wittig protocols and troublesome for the two previous total syntheses. A general Z-selective cross-metathesis protocol to construct (Z)-β,γ-unsaturated esters was also developed that has broad functional group tolerance and high stereoselectivity. Additionally, our synthesis already accumulated 75 mg of valuable material for an 18 O-tricyclic-PGDM-based assay used in clinical settings for inflammation.
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Affiliation(s)
- Hunter S Sims
- Department of Chemistry and Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA
| | - Pedro de Andrade Horn
- Department of Chemistry and Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA
| | - Ryota Isshiki
- Department of Chemistry and Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA
- Department of Applied Chemistry, Waseda University, Shinjuku, Tokyo, 162-0041, Japan
| | - Melissa Lim
- Department of Chemistry and Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA
| | - Yan Xu
- The Arnold and Mabel Beckman Laboratory of Chemical Synthesis, Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Robert H Grubbs
- The Arnold and Mabel Beckman Laboratory of Chemical Synthesis, Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Mingji Dai
- Department of Chemistry and Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA
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21
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Sims HS, Andrade Horn P, Isshiki R, Lim M, Xu Y, Grubbs RH, Dai M. Catalysis‐Enabled Concise and Stereoselective Total Synthesis of the Tricyclic Prostaglandin D
2
Metabolite Methyl Ester. Angew Chem Int Ed Engl 2022. [DOI: 10.1002/ange.202115633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hunter S. Sims
- Department of Chemistry and Center for Cancer Research Purdue University West Lafayette IN 47907 USA
| | - Pedro Andrade Horn
- Department of Chemistry and Center for Cancer Research Purdue University West Lafayette IN 47907 USA
| | - Ryota Isshiki
- Department of Chemistry and Center for Cancer Research Purdue University West Lafayette IN 47907 USA
- Department of Applied Chemistry Waseda University Shinjuku Tokyo 162-0041 Japan
| | - Melissa Lim
- Department of Chemistry and Center for Cancer Research Purdue University West Lafayette IN 47907 USA
| | - Yan Xu
- The Arnold and Mabel Beckman Laboratory of Chemical Synthesis Division of Chemistry and Chemical Engineering California Institute of Technology Pasadena CA 91125 USA
| | - Robert H. Grubbs
- The Arnold and Mabel Beckman Laboratory of Chemical Synthesis Division of Chemistry and Chemical Engineering California Institute of Technology Pasadena CA 91125 USA
| | - Mingji Dai
- Department of Chemistry and Center for Cancer Research Purdue University West Lafayette IN 47907 USA
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22
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Pitman B, Lim M, Margaritis C, Mills N, Wong C, Sanders P, Lau D. Characterisation Of Implantable Cardioverter Defibrillator (ICD) Patients Receiving Elective In-hospital Palliative Device Deactivation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Rosello R, Girela-Serrano B, Gómez S, Baig B, Lim M, Taylor S. Characterizing the features and course of psychiatric symptoms in children and adolescents with autoimmune encephalitis. Eur Arch Psychiatry Clin Neurosci 2022; 272:477-482. [PMID: 34272976 PMCID: PMC8938365 DOI: 10.1007/s00406-021-01293-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/04/2021] [Indexed: 01/14/2023]
Abstract
Autoimmune encephalitis (AE) can present like a psychiatric disorder. We aimed to illustrate the psychiatric manifestations, course and management of AE in a paediatric cohort. Neuropsychiatric symptoms, investigations and treatment were retrospectively retrieved in 16 patients (mean age 11.31, SD 2.98) with an AE diagnosis at the liaison psychiatry services in two UK tertiary paediatric centres. Psychiatric presentation was characterised by an acute polysymptomatic (predominantly agitation, anger outbursts/aggressiveness, hallucinations, and emotional lability) onset. Antipsychotics produced side effects and significant worsening of symptoms in four cases, and benzodiazepines were commonly used. This psychiatric phenotype should make clinicians suspect the diagnosis of AE and carefully consider use of treatments.
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Affiliation(s)
- R Rosello
- Division of Psychiatry, Imperial College, London, UK
| | | | - S Gómez
- Division of Psychiatry, King’s College, London, UK
| | - B Baig
- South London and Maudsley NHS Trust, London, UK
| | - M Lim
- Children's Neurosciences Centre, Evelina London Children's Hospital, London, UK. .,Department Women and Children's Health, School of Life Course Sciences (SoLCS), King's College London, London, UK.
| | - S Taylor
- Division of Psychiatry, Imperial College, London, UK
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24
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Pitman B, Zanker A, Lim M, McLoughney J, Tarone R, McInnes K, Heath K, Gieve M, Evans S, Wong C, Sanders P, Lau D. Optimal Sensing Vector Orientation For Maximal R-Wave Amplitude, Implications for Insertable Cardiac Monitor (ICM) Implantation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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25
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Lin T, Siu C, Redmond K, Bettegowda C, Jackson C, Lim M, Kleinberg L. Utility of Short Initial MRI Brain in Brain Metastases Patients Treated With Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Salzedo S, Brust L, Herrin B, Mount S, Akong K, Lim M. 67: Quality improvement: Identifying food insecurity (FI) in families with children with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01492-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Nakamura A, Zeng F, Nakamura S, Reid KT, Gracey E, Lim M, Leng L, Jo S, Park YS, Kusuda M, Machhar R, Boroojeni SF, Wu B, Rossomacha E, Kim TH, Ciccia F, Rockel JS, Kapoor M, Inman RD, Jurisica I, Crome SQ, Bucala R, Haroon N. Macrophage migration inhibitory factor drives pathology in a mouse model of spondyloarthritis and is associated with human disease. Sci Transl Med 2021; 13:eabg1210. [PMID: 34669443 DOI: 10.1126/scitranslmed.abg1210] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Akihiro Nakamura
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Division of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario M5T 2S8, Canada.,Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Fanxing Zeng
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Sayaka Nakamura
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Kyle T Reid
- Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada.,Toronto General Hospital Research Institute, Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario M5G 2C4, Canada
| | - Eric Gracey
- Unit Molecular Immunology and Inflammation, Inflammation Research Institute, VIB-Ghent University, 9000 Ghent, Belgium.,Department of Rheumatology, Universitair Ziekenhuis Ghent, University of Gent, 9000 Ghent, Belgium
| | - Melissa Lim
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Lin Leng
- Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Sungsin Jo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul 04763, Republic of Korea
| | - Ye-Soo Park
- Department of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri 11293, Republic of Korea
| | - Masaki Kusuda
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Rohan Machhar
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Shaghayegh F Boroojeni
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Brian Wu
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Evgeny Rossomacha
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul 04763, Republic of Korea
| | - Francesco Ciccia
- Department of Precision Medicine, University della Campania L. Vanvitelli, 80131 Naples, Italy
| | - Jason S Rockel
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Mohit Kapoor
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada
| | - Robert D Inman
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Division of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario M5T 2S8, Canada.,Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Igor Jurisica
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Departments of Medical Biophysics and Computer Science, University of Toronto, Toronto, Ontario M5G 1L7, Canada.,Institute of Neuroimmunology, Slovak Academy of Sciences, 85410 Bratislava, Slovakia
| | - Sarah Q Crome
- Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada.,Toronto General Hospital Research Institute, Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario M5G 2C4, Canada
| | - Richard Bucala
- Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Nigil Haroon
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario M5T 0S8, Canada.,Division of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario M5T 2S8, Canada.,Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
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Lewis JC, Lim M, Lai L, Mendoza E, Albertson TE, Chenoweth JA. Evaluation of N-acetylcysteine dose for the treatment of massive acetaminophen ingestion. Clin Toxicol (Phila) 2021; 60:507-513. [PMID: 34581655 DOI: 10.1080/15563650.2021.1984503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
METHODS The use of N-acetylcysteine (NAC) remains the standard of care for treatment of acetaminophen (APAP) toxicity and overdose. Currently, there is growing evidence to suggest that massive acetaminophen overdose is associated with increased hepatotoxicity despite timely administration of NAC. This raises the question as to whether an increased dose of intravenous (IV) NAC should be used in the setting of massive APAP ingestion. This study aimed to evaluate the rate of hepatotoxicity after massive APAP overdose treated with 3 different NAC treatment regimens. METHODS This was a retrospective cohort study conducted by electronic medical record review of cases reported to a statewide poison control system between 2007 and 2020. Inclusion criteria were single APAP or APAP combination-medication ingestion; acute massive acetaminophen (APAP) ingestion (defined as APAP concentration ≥ 2 times above the Rumack-Matthew 150 nomogram); received one of the three NAC regimens: standard dose IV NAC, oral (PO) NAC, or high dose IV NAC. The risk of hepatotoxicity was evaluated using a multivariate logistic regression model with standard dose IV NAC as the base variable for comparison. RESULTS A total of 373 patients met inclusion for the study. Of those, 135 cases were treated with standard dose IV NAC, 121 cases treated with PO NAC, and 117 cases treated with high dose IV NAC. The risk of developing hepatotoxicity was not statistically significant between the high dose IV NAC (OR 1.05, 95% CI 0.52 - 2.09) or oral NAC (OR 0.69, 95% CI 0.33 - 1.46) when compared to standard dose IV NAC. When adjusted for APAP combination medications, initial APAP ratio, initial elevated AST/ALT, and treatment within 8 h, there remained no difference between treatment regimens. CONCLUSION This study was unable to detect a large absolute reduction in the rate of hepatotoxicity after massive APAP ingestion in patients treated with high dose IV NAC or PO NAC when compared to standard dose IV NAC; even when treatment was initiated within 8 h of ingestion.
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Affiliation(s)
- J C Lewis
- Sacramento Division, California Poison Control System, Sacramento, CA, USA.,University of California San Francisco School of Pharmacy, San Francisco, CA, USA.,Department of Internal Medicine, University of California Davis Health, Sacramento, CA, USA
| | - M Lim
- Department of Pharmacy Services, University of California Davis Health, Sacramento, CA, USA
| | - L Lai
- Sacramento Division, California Poison Control System, Sacramento, CA, USA
| | - E Mendoza
- University of California San Francisco School of Pharmacy, San Francisco, CA, USA
| | - T E Albertson
- Sacramento Division, California Poison Control System, Sacramento, CA, USA.,University of California San Francisco School of Pharmacy, San Francisco, CA, USA.,Department of Internal Medicine, University of California Davis Health, Sacramento, CA, USA
| | - J A Chenoweth
- Sacramento Division, California Poison Control System, Sacramento, CA, USA.,Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
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Wyborn C, Montana J, Kalas N, Clement S, Davila F, Knowles N, Louder E, Balan M, Chambers J, Christel L, Forsyth T, Henderson G, Izquierdo Tort S, Lim M, Martinez‐Harms MJ, Merçon J, Nuesiri E, Pereira L, Pilbeam V, Turnhout E, Wood S, Ryan M. An agenda for research and action toward diverse and just futures for life on Earth. Conserv Biol 2021; 35:1086-1097. [PMID: 33244774 PMCID: PMC8359367 DOI: 10.1111/cobi.13671] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 06/11/2023]
Abstract
Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.
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Affiliation(s)
- C. Wyborn
- Luc Hoffmann InstituteIUCN Conservation CentreRue Mauverney 28Gland1196Switzerland
- Institute for Water Futures, Fenner School of Environment and SocietyAustralian National UniversityCanberraACT0200Australia
| | - J. Montana
- School of Geography and the EnvironmentUniversity of OxfordSouth Parks RoadOxfordOX1 3QYU.K.
| | - N. Kalas
- Department of Environmental Systems ScienceETH ZürichUniversitätstrasse 8‐22Zürich8092Switzerland
| | - S. Clement
- Geography and PlanningUniversity of LiverpoolLiverpoolL69 3BXU.K.
| | - F. Davila
- Institute for Sustainable FuturesUniversity of Technology Sydney253 Jones StreetUltimoNSW2007Australia
| | - N. Knowles
- Department of Geography and Environmental ManagementUniversity of Waterloo200 University Ave WWaterlooONN2L 3G1Canada
| | - E. Louder
- School of Geography and DevelopmentUniversity of ArizonaENR2 Building, South 4th floor 1064 E. Lowell StreetTucsonAZ85721U.S.A.
| | - M. Balan
- The Forest WayNo 8, 2nd St, D P Nagar, KotturpuramChennaiTamil Nadu600085India
| | - J. Chambers
- Forest and Nature Conservation Policy GroupWageningen UniversityP.O. Box 47Wageningen6700 AAThe Netherlands
| | - L. Christel
- School of Politics and Government (EPyG)National University of San MartinAvenida 25 de Mayo 1021San MartínProvincia de Buenos Aires1650Argentina
| | - T. Forsyth
- Department of International DevelopmentLondon School of Economics and Political ScienceHoughton StreetLondonWC2A 2AEU.K
| | - G. Henderson
- Harry Ransom CenterThe University of Texas at AustinP.O. Drawer 7219, 300 W 21st StreetAustinTX78712U.S.A.
| | - S. Izquierdo Tort
- Institut des Sciences de la Forêt TempéréeUniversité du Québec en Outaouais58 rue PrincipaleRiponQCJ0V 1V0Canada
- Natura y Ecosistemas Mexicanos A.C.Plaza San Jacinto 23D, San Ángel, Álvaro ObregónMexico City01000Mexico
| | - M. Lim
- Centre for Environmental Law, Macquarie Law SchoolMacquarie University6 First WalkSydneyNSW2109Australia
| | - M. J. Martinez‐Harms
- Center for Applied Ecology and Sustainability (CAPES)Pontificia Universidad Católica de ChileSantiago, Avd. Libertador Bernardo O'Higgins 340SantiagoChile
| | - J. Merçon
- Instituto de Investigaciones en EducasiónUniversidad VeracruzanaPaseo 112, Nuevo JalapaXalapa‐Enríquez91193Mexico
| | - E. Nuesiri
- Social Science FacultyAfrican Leadership University (ALU)Powder Mill RoadPamplemousses21001Mauritius
| | - L. Pereira
- Stockholm Resilience CentreStockholm UniversityKräftriket 2BStockholmSE‐10691Sweden
- Copernicus Institute of Sustainable DevelopmentUtrecht UniversityPrincetonlaan 8aUtrecht3584 CBThe Netherlands
- Centre for Complex Systems in TransitionStellenbosch University19 Jonkershoek Rd, MostertsdriftStellenbosch7600South Africa
| | - V. Pilbeam
- Clear Horizon Consulting132B Gwynne StCremorneVIC3121Australia
| | - E. Turnhout
- Forest and Nature Conservation Policy GroupWageningen UniversityP.O. Box 47Wageningen6700 AAThe Netherlands
| | - S. Wood
- Future Earth1250 Guy St, MontrealQuebecONH3H 2L3Canada
| | - M. Ryan
- Luc Hoffmann InstituteIUCN Conservation CentreRue Mauverney 28Gland1196Switzerland
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Wyborn C, Montana J, Kalas N, Clement S, Davila F, Knowles N, Louder E, Balan M, Chambers J, Christel L, Forsyth T, Henderson G, Izquierdo Tort S, Lim M, Martinez-Harms MJ, Merçon J, Nuesiri E, Pereira L, Pilbeam V, Turnhout E, Wood S, Ryan M. An agenda for research and action toward diverse and just futures for life on Earth. Conserv Biol 2021; 35:1086-1097. [PMID: 33244774 DOI: 10.13140/rg.2.2.12086.52804/2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 05/18/2023]
Abstract
Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.
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Affiliation(s)
- C Wyborn
- Luc Hoffmann Institute, IUCN Conservation Centre, Rue Mauverney 28, Gland, 1196, Switzerland
- Institute for Water Futures, Fenner School of Environment and Society, Australian National University, Canberra, ACT, 0200, Australia
| | - J Montana
- School of Geography and the Environment, University of Oxford, South Parks Road, Oxford, OX1 3QY, U.K
| | - N Kalas
- Department of Environmental Systems Science, ETH Zürich, Universitätstrasse 8-22, Zürich, 8092, Switzerland
| | - S Clement
- Geography and Planning, University of Liverpool, Liverpool, L69 3BX, U.K
| | - F Davila
- Institute for Sustainable Futures, University of Technology Sydney, 253 Jones Street, Ultimo, NSW, 2007, Australia
| | - N Knowles
- Department of Geography and Environmental Management, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - E Louder
- School of Geography and Development, University of Arizona, ENR2 Building, South 4th floor 1064 E. Lowell Street, Tucson, AZ, 85721, U.S.A
| | - M Balan
- The Forest Way, No 8, 2nd St, D P Nagar, Kotturpuram, Chennai, Tamil Nadu, 600085, India
| | - J Chambers
- Forest and Nature Conservation Policy Group, Wageningen University, P.O. Box 47, Wageningen, 6700 AA, The Netherlands
| | - L Christel
- School of Politics and Government (EPyG), National University of San Martin, Avenida 25 de Mayo 1021, San Martín, Provincia de Buenos Aires, 1650, Argentina
| | - T Forsyth
- Department of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, U.K
| | - G Henderson
- Harry Ransom Center, The University of Texas at Austin, P.O. Drawer 7219, 300 W 21st Street, Austin, TX, 78712, U.S.A
| | - S Izquierdo Tort
- Institut des Sciences de la Forêt Tempérée, Université du Québec en Outaouais, 58 rue Principale, Ripon, QC, J0V 1V0, Canada
- Natura y Ecosistemas Mexicanos A.C., Plaza San Jacinto 23D, San Ángel, Álvaro Obregón, Mexico City, 01000, Mexico
| | - M Lim
- Centre for Environmental Law, Macquarie Law School, Macquarie University, 6 First Walk, Sydney, NSW, 2109, Australia
| | - M J Martinez-Harms
- Center for Applied Ecology and Sustainability (CAPES), Pontificia Universidad Católica de Chile, Santiago, Avd. Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - J Merçon
- Instituto de Investigaciones en Educasión, Universidad Veracruzana, Paseo 112, Nuevo Jalapa, Xalapa-Enríquez, 91193, Mexico
| | - E Nuesiri
- Social Science Faculty, African Leadership University (ALU), Powder Mill Road, Pamplemousses, 21001, Mauritius
| | - L Pereira
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, Stockholm, SE-10691, Sweden
- Copernicus Institute of Sustainable Development, Utrecht University, Princetonlaan 8a, Utrecht, 3584 CB, The Netherlands
- Centre for Complex Systems in Transition, Stellenbosch University, 19 Jonkershoek Rd, Mostertsdrift, Stellenbosch, 7600, South Africa
| | - V Pilbeam
- Clear Horizon Consulting, 132B Gwynne St, Cremorne, VIC, 3121, Australia
| | - E Turnhout
- Forest and Nature Conservation Policy Group, Wageningen University, P.O. Box 47, Wageningen, 6700 AA, The Netherlands
| | - S Wood
- Future Earth, 1250 Guy St, Montreal, Quebec, ON, H3H 2L3, Canada
| | - M Ryan
- Luc Hoffmann Institute, IUCN Conservation Centre, Rue Mauverney 28, Gland, 1196, Switzerland
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Camilleri-Brennan J, Lim M. 555 The Unintended Consequences Of COVID-19 on the Quality of Documentation of Operation-Notes. Br J Surg 2021. [PMCID: PMC8135968 DOI: 10.1093/bjs/znab134.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Operation-notes are crucial as they impact on the care of patients post-operatively. During COVID-19, a sizeable proportion of General Surgical procedures were performed at a local “cold” site private hospital. This study aims to determine the direct impact of COVID-19 on the standard of operation-note documentation at a non-routine site compared to our routine site. Method The Royal College of Surgeons Good Surgical Practice guidance highlights 19 key-variables to record within operation-notes. 300 consecutive operations were identified between May and August 2020 and details of electronic operation-notes collected. Throughout this study period, educational emails and posters were introduced at both sites secondary to ongoing audit. Results 228/300 (76%) operations took place at our main hospital. The remainder were commissioned to the other. Operating surgeons and anaesthetists were similar at both sites. Quality of documentation was poorer for many key variables at the cold site when compared with the main site (operating-surgeons (22% vs 91%), urgency of operation (62% vs 99%), antibiotic prophylaxis (72% vs 99%) and DVT prophylaxis (21% vs 98%)). Conclusions COVID-19 has resulted in many unintended consequences including a reduction in the quality of operation-notes. Moving forward, this may be reduced by improving information technology resources and increasing awareness and education.
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Affiliation(s)
| | - M Lim
- York Teaching Hospital NHS Foundation Trust, York, United Kingdom
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Abbakar M, James T, Boxall P, Lim M. 658 An Audit of Frequency of Cancer Genetics Referral in Patients with a Family History of Colorectal Cancer. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Guidelines on the management of hereditary colorectal cancers were updated in 2019. In this study, data from patients within the colonoscopy surveillance programme for hereditary cancer at York Teaching Hospitals Trust were analysed to assess category of risk and appropriateness of referrals to regional geneticists.
Method
After examination of electronic records and clinical notes, patients were assigned a risk category of average, moderate or high according to the Amsterdam criteria and latest BSG/ACPGBI/UKCGG guidelines. Patients were then assessed to see if a concurrent referral had been made to the regional cancer genetic services.
Results
There were 228 patients. 72(31.6%) patients were in the average, 81(35.5%) in the moderate and 41(18%) were in the high-risk category. 34 (14.9%) patients with insufficient data and/or assessments were in the indeterminate category.
18 of 72 (25%) patients with average risk were unnecessarily referred to the regional genetics team, while 5/41(12%) of high-risk patients were not. A large proportion of patients with insufficient data (19/34, 55.8%) were rightly or wrongly, referred to the regional genetics team.
Conclusions
Assessment of hereditary cancer risk is difficult in the absence of good quality information. Risk assessment may be improved with use of a dedicated family history questionnaire/template - this facilitates identification of high-risk patients that benefit most from referral to geneticists.
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Affiliation(s)
- M Abbakar
- York Teaching Hospitals NHS Trust, Scarborough, United Kingdom
| | - T James
- York Teaching Hospitals NHS Trust, Scarborough, United Kingdom
| | - P Boxall
- York Teaching Hospitals NHS Trust, Scarborough, United Kingdom
| | - M Lim
- York Teaching Hospitals NHS Trust, Scarborough, United Kingdom
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Abbakar M, Boxall P, James T, Lim M. 913 An Audit of Colonoscopy Compliance Within A Screening Programme for Patients with A Family History of Colorectal Cancer (CRC). Br J Surg 2021. [DOI: 10.1093/bjs/znab134.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Guidelines on the management of hereditary CRC were updated in 2019 and have led to more stringent use of surveillance colonoscopies. Patients with ‘family history’ (FH) CRC Surveillance programme at York Hospitals Trust were studied to assess compliance with colonoscopy recommendations.
Method
Current BSG/ACPGBI guidelines recommend biennial, quinquennial, one-off or no colonoscopy surveillance for patients with Lynch syndrome, and those deemed to have high, moderate, and average risks of developing hereditary cancer, respectively.
Examination of electronic records and clinical notes were performed to determine if they were Lynch positive and/or if they could be assigned a risk category.
Results
Database of 227 patients, of which 14 were high, 61 moderate and 45 were low risk. 47 had Lynch syndrome. Compliance of colonoscopy was poor for patients with average and moderate FH risk (both 0%). Compliance was higher for patients with high risk of FH (50%) and those with Lynch syndrome (57%)
Risk was indeterminate in 24 patients due to inadequate data therefore compliance could not be assessed.
Conclusions
A large proportion of patients with low to moderate ‘FH’ risk within our current surveillance programme had unnecessary colonoscopies. Stratification of patients into the appropriate risk categories optimizes the benefit from surveillance programmes.
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Affiliation(s)
- M Abbakar
- York Teaching Hospitals NHS Trust, Scarborough, United Kingdom
| | - P Boxall
- York Teaching Hospitals NHS Trust, Scarborough, United Kingdom
| | - T James
- York Teaching Hospitals NHS Trust, Scarborough, United Kingdom
| | - M Lim
- York Teaching Hospitals NHS Trust, Scarborough, United Kingdom
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Qaiyum Z, Lim M, Inman RD. The gut-joint axis in spondyloarthritis: immunological, microbial, and clinical insights. Semin Immunopathol 2021; 43:173-192. [PMID: 33625549 DOI: 10.1007/s00281-021-00845-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
The strong genetic and clinical overlaps between spondyloarthritis (SpA) and inflammatory bowel disease (IBD) have placed much needed focus on the gut-joint axis of inflammation in SpA, leading to three key hypotheses that attempt to unravel this complex relationship. The arthritogenic peptide hypothesis and the aberrant cellular trafficking hypothesis have been put forth to rationalize the manner by which the innate and adaptive immune systems cooperate and converge during SpA pathogenesis. The bacterial dysbiosis hypothesis discusses how changes in the microbiome lead to architectural and immunological consequences in SpA. These theories are not mutually exclusive, but can provide an explanation as to why subclinical gut inflammation may sometimes precede joint inflammation in SpA patients, thereby implying a causal relationship. Such investigations will be important in informing therapeutic decisions which may be common to both SpA and IBD. However, these hypotheses can also offer insights for a coincident inflammatory relationship between the gut and the joint, particularly when assessing the immunological players involved. Insights from understanding how these systems might affect the gut and joint differently will be equally imperative to address where the therapeutic differences lie between the two diseases. Collectively, this knowledge has practical implications in predicting the likelihood of IBD development in SpA or presence of coincident SpA-IBD, uncovering novel therapeutic targets, and redesigning currently approved treatments. It is evident that a multidisciplinary approach between the rheumatology and gastroenterology fields cannot be ignored, when it comes to the care of SpA patients at risk of IBD or vice versa.
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Affiliation(s)
- Zoya Qaiyum
- Schroeder Arthritis Institute, University Health Network, 60 Leonard Avenue, 5, Toronto, Ontario, KD-408, Canada
| | - Melissa Lim
- Schroeder Arthritis Institute, University Health Network, 60 Leonard Avenue, 5, Toronto, Ontario, KD-408, Canada
| | - Robert D Inman
- Schroeder Arthritis Institute, University Health Network, 60 Leonard Avenue, 5, Toronto, Ontario, KD-408, Canada.
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Abstract
The analysis of brain signal variability is a promising approach to understand pathological brain function related to chronic pain. This study investigates whether blood-oxygen-level-dependent signal variability (BOLDSV) in specific frequency bands is altered in temporomandibular disorder (TMD) and correlated to its clinical features. Twelve patients with chronic myofascial TMD and 24 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging. The BOLDSV was measured as the standard deviation of the BOLD time series at each voxel and compared between groups. We also examined the potential relationship between the BOLDSV and the catechol-O-methyltransferase (COMT) Val158Met polymorphism. We assessed sensory-discriminative pain in the craniofacial region, pain sensitivity to sustained masseteric pain challenge, and TMD pain frequency for clinical correlation. Patients displayed reduced BOLDSV in the dorsolateral prefrontal cortex (dlPFC) as compared with HC in all frequency bands. In the slow-3 band, patients also showed reduced BOLDSV in the medial dorsal thalamus, primary motor cortex (M1), and primary somatosensory cortex (S1) and heightened BOLDSV in the temporal pole. Notably, we found a significant correlation between lower BOLDSV (slow-3) in the orofacial M1/S1 regions and higher clinical pain (intensity/area) and higher sensitivity of the masseter muscle pain. Moreover, lower BOLDSV (slow-3) in the dlPFC and ventrolateral PFC was associated with a higher TMD pain frequency. Participants who had the COMT 158Met substitution exhibited lower BOLDSV in the dlPFC and higher BOLDSV in the temporal pole as compared with participants without the COMT 158Met substitution. An increasing number of Met alleles was associated with lower dlPFC and greater temporal pole BOLDSV in both HC and TMD groups. Together, we demonstrated that chronic TMD patients exhibit aberrant BOLDSV in the top-down pain modulatory and sensorimotor circuits associated with their pain frequency and severity. COMT Val158Met polymorphism might affect clinical symptoms in association with regional brain signal variability, specifically involved in cognitive and emotional regulation of pain.
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Affiliation(s)
- M Lim
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
| | - T D Nascimento
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
| | - D J Kim
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
| | - V L Ellingrod
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - A F DaSilva
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA.,Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
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Pitman B, Chew S, Wong C, Jaghoori A, Iwai S, Lyrtzis E, Lim M, Chew R, Chew A, Sanders P, Lau D. Atrial Fibrillation Prevalence and Risk Factors in a Semi-Rural African Population: Findings From the Australian-led TEFF-AF Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gracey E, Hromadová D, Lim M, Qaiyum Z, Zeng M, Yao Y, Srinath A, Baglaenko Y, Yeremenko N, Westlin W, Masse C, Müller M, Strobl B, Miao W, Inman RD. TYK2 inhibition reduces type 3 immunity and modifies disease progression in murine spondyloarthritis. J Clin Invest 2020; 130:1863-1878. [PMID: 32149730 PMCID: PMC7108927 DOI: 10.1172/jci126567] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/14/2020] [Indexed: 12/17/2022] Open
Abstract
Spondyloarthritis (SpA) represents a family of inflammatory diseases of the spine and peripheral joints. Ankylosing spondylitis (AS) is the prototypic form of SpA in which progressive disease can lead to fusion of the spine. Therapeutically, knowledge of type 3 immunity has translated into the development of IL-23– and IL-17A–blocking antibodies for the treatment of SpA. Despite being able to provide symptomatic control, the current biologics do not prevent the fusion of joints in AS patients. Thus, there is an unmet need for disease-modifying drugs. Genetic studies have linked the Janus kinase TYK2 to AS. TYK2 is a mediator of type 3 immunity through intracellular signaling of IL-23. Here, we describe and characterize a potentially novel small-molecule inhibitor of TYK2 that blocked IL-23 signaling in vitro and inhibited disease progression in animal models of SpA. The effect of the inhibitor appears to be TYK2 specific, using TYK2-inactive mice, which further revealed a duality in the induction of IL-17A and IL-22 by IL-23. Specifically, IL-22 production was TYK2/JAK2/STAT3 dependent, while IL-17A was mostly JAK2 dependent. Finally, we examined the effects of AS-associated TYK2 SNPs on TYK2 expression and function and correlated them with AS disease progression. This work provides evidence that TYK2 inhibitors have great potential as an orally delivered therapeutic for SpA.
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Affiliation(s)
- Eric Gracey
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Spondylitis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Dominika Hromadová
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine, Vienna, Austria
| | - Melissa Lim
- Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Spondylitis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Zoya Qaiyum
- Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Spondylitis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael Zeng
- Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Spondylitis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Yuchen Yao
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Spondylitis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Archita Srinath
- Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Spondylitis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Yuriy Baglaenko
- Divisions of Genetics and Rheumatology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Yeremenko
- Division of Clinical Immunology and Rheumatology, Department of Experimental Immunology, Academic Medical Center, Amsterdam, Netherlands
| | | | - Craig Masse
- Nimbus Therapeutics, Cambridge, Massachusetts, USA
| | - Mathias Müller
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine, Vienna, Austria
| | - Birgit Strobl
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine, Vienna, Austria
| | - Wenyan Miao
- Nimbus Therapeutics, Cambridge, Massachusetts, USA
| | - Robert D Inman
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Spondylitis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Baker B, Redmond K, Siu C, Bettegowda C, Lim M, Kleinberg L. Impact Of Lag From Simulation To Start Of Treatment On Local Control Of Brain Metastases Treated With Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tang L, Ho K, Tam R, Hawkins N, Lim M, Andrade J. Machine learning for predicting AF ablation outcomes using daily heart rhythm data at baseline. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
While numerous studies have shown that catheter ablation is superior to antiarrhythmic drug (AAD) in treating atrial fibrillation (AF), the long term outcomes have been limited by arrhythmia recurrence. Reliable data and methods to predict ablation outcomes will thus be valuable for treatment planning.
Objective
To evaluate the utility of machine learning and various types of input variables, viz. patient characteristics at baseline, and daily heart rhythm data recorded prior to ablation for outcome prediction.
Methods
We acquired permission to analyze data collected from a randomized clinical trial that recorded daily biomeasures from >345 patients who were referred for first catheter ablation due to AF refractory to at least one AAD. After standardizing the dataset, each patient sample is characterized by a set of daily measures, viz. heart rate variability (HRV) and AF burden (AFB), which is the total minutes in AF per day. We next performed comparative analyses on 19 candidate model variants to evaluate each model's ability in identifying patients who were to experience at least one episode of AF recurrence during post-ablation period starting from day 91 up to day 365 post-ablation, per standard guidelines. We examined: i) use of a set of daily biomeasures jointly with baseline sex and age; and ii) observation lengths of the pre-ablation period. We also examined the use of baseline CHA2DS2-VASc scores, left-atrial volume (LAV), atrial diameter, medical history. We conducted multiple sets of 3-fold cross validation (CV) experiments, each fold independently trained a candidate model with 236 samples (two thirds of the dataset) and performed evaluation on the left-out samples. About 50% of cohort belongs to one class. Each fold scored a model and its input variables in terms of sensitivity (SEN), specificity (SPEC), area under receiver operating characteristic curve (AUC), etc. To circumvent risks of overfitting highly parameterized models to our training subset, we shortlisted 19 models that have few hyper-parameters, e.g. stepwise regression, random forest (RF), linear discriminant analysis (LDA).
Results
CV results demonstrated that LDA and RF gave comparable performances, with RF achieving highest AUC of 0.68±0.06 using 30 days of rhythm data prior to ablation (SEN of 65.9±7.82; SPEC of 66.3±0.57). When observation period extended to 90 days prior, AUC improved to 0.691±0.02. In contrast, use of LAV alone was not adequate to predict outcome (AUC∼0.5), and when combined with all aforementioned baseline variables, the best model achieved AUC of 0.58±0.05. Feature analyses from the trained models suggest that AFB had highest relevance in predicting outcome. Using only daily AFB, RF and LDA respectively achieved AUC of 0.608±0.04 and 0.652±0.04.
Conclusions
Our results suggest the value of pre-ablation rhythm data for improving outcome-prediction. Future work will validate these findings using large public datasets.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Huawei-Data Science Institute Research Program; Natural Sciences and Engineering Research Council of Canada (NSERC)
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Affiliation(s)
- L Tang
- University of British Columbia, Vancouver, Canada
| | - K Ho
- University of British Columbia, Vancouver, Canada
| | - R Tam
- University of British Columbia, Vancouver, Canada
| | - N Hawkins
- University of British Columbia, Vancouver, Canada
| | - M Lim
- University of British Columbia, Vancouver, Canada
| | - J Andrade
- University of British Columbia, Vancouver, Canada
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Khanabdali R, Shojaee M, Johnson J, Law S, Whitmore M, Lim M, Schoppet M, Silva A, James P, Kalionis B, Dixon I, Lichtfuss GG, Tester A. Characterization of extracellular vesicles derived from two populations of human placenta derived mesenchymal stem/stromal cells. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gracey E, Yao Y, Qaiyum Z, Lim M, Tang M, Inman RD. Altered Cytotoxicity Profile of CD8+ T Cells in Ankylosing Spondylitis. Arthritis Rheumatol 2020; 72:428-434. [PMID: 31599089 DOI: 10.1002/art.41129] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 10/01/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) is an inflammatory arthritis in which men have a higher risk of developing progressive axial disease than women. Transcriptomic studies have shown reduced expression of cytotoxic cell genes in the blood of AS patients. HLA-B27 contributes the greatest risk for AS, suggesting a role for CD8+ T cells. This study was undertaken to profile AS patient cytotoxic cells with the hypothesis that an alteration in CD8+ T cells might explain the aberrant cytotoxic profile observed in patients. METHODS Whole blood was examined for GZM and PRF1 gene expression by quantitative polymerase chain reaction. Serum and synovial fluid (SF) were examined for granzyme and perforin 1 expression by bead array, and blood and SF mononuclear cells were examined for granzyme and perforin 1 expression by fluorescence-activated cell sorting (FACS). RESULTS GZM and PRF1 gene expression were both reduced in AS patients compared to healthy controls, especially in men. Perforin 1, but not granzyme, protein levels were reduced in AS patient serum. Granzymes were elevated in AS SF, but not in rheumatoid arthritis or osteoarthritis SF. FACS revealed a reduction in granzyme-positive and perforin 1-positive lymphocytes, but not an intrinsic defect in CD8+ T cell granzyme or perforin 1 production. CD8+ T cell frequency was reduced in the blood and increased in the SF of AS patients. CONCLUSION Our findings indicate that AS patients have an altered cytotoxic T cell profile. These data suggest that CD8+ T cells with a cytotoxic phenotype are recruited to the joints, where they exhibit an activated phenotype. Thus, a central role for CD8+ T cells in AS may have been overlooked and deserves further study.
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Affiliation(s)
- Eric Gracey
- University of Toronto, Krembil Research Institute, Toronto Western Hospital, and University Health Network, Toronto, Ontario, Canada
| | - Yuchen Yao
- University of Toronto, Krembil Research Institute, and University Health Network, Toronto, Ontario, Canada
| | - Zoya Qaiyum
- Krembil Research Institute, Toronto Western Hospital, and University Health Network, Toronto, Ontario, Canada
| | - Melissa Lim
- Krembil Research Institute, Toronto Western Hospital, and University Health Network, Toronto, Ontario, Canada
| | - Michael Tang
- Krembil Research Institute, Toronto Western Hospital, and University Health Network, Toronto, Ontario, Canada
| | - Robert D Inman
- University of Toronto, Krembil Research Institute, Toronto Western Hospital, and University Health Network, Toronto, Ontario, Canada
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Lim M, Strange G, Playford D, Celermajer D. 652 Bicuspid Aortic Valve – A Community-Based Study of 4,999 Adults From the National Echo Database of Australia (NEDA). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lim M, Playford D, Strange G, Celermajer D. 655 Different Clinical Features of Bicuspid Versus Tricuspid Aortic Stenosis; a Study From the National Echo Database of Australia (NEDA). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lim M, Celermajer D. 666 Implications of Concomitant Bicuspid Aortic Valve in Patients With Aortic Coarctation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lim M, Brown HM, Kind KL, Breen J, Anastasi MR, Ritter LJ, Tregoweth EK, Dinh DT, Thompson JG, Dunning KR. Haemoglobin expression in in vivo murine preimplantation embryos suggests a role in oxygen-regulated gene expression. Reprod Fertil Dev 2019; 31:724-734. [PMID: 30482269 DOI: 10.1071/rd17321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/24/2018] [Indexed: 01/17/2023] Open
Abstract
Haemoglobin expression is not restricted to erythroid cells. We investigated the gene expression of the haemoglobin subunits haemoglobin, alpha adult chain 1 (Hba-a1) and haemoglobin, beta (Hbb), 2,3-bisphosphoglycerate mutase (Bpgm) and the oxygen-regulated genes BCL2/adenovirus E1B interacting protein 3 (Bnip3), solute carrier family 2 (facilitated glucose transporter), member 1 (Slc2a1) and N-myc downstream regulated gene 1 (Ndrg1) in the murine preimplantation embryo, comparing invivo to invitro gene expression. Relatively high levels of Hba-a1 and Hbb were expressed invivo from the 2-cell to blastocyst stage; in contrast, little or no expression occurred invitro. We hypothesised that the presence of haemoglobin invivo creates a low oxygen environment to induce oxygen-regulated gene expression, supported by high expression of Slc2a1 and Ndrg1 in invivo relative to invitro embryos. In addition, analysis of an invitro-derived human embryo gene expression public dataset revealed low expression of haemoglobin subunit alpha (HBA) and HBB, and high expression of BPGM. To explore whether there was a developmental stage-specific effect of haemoglobin, we added exogenous haemoglobin either up to the 4-cell stage or throughout development to the blastocyst stage, but observed no difference in blastocyst rate or the inner cell mass to trophectoderm cell ratio. We conclude that haemoglobin in the invivo preimplantation embryo raises an interesting premise of potential mechanisms for oxygen regulation, which may influence oxygen-regulated gene expression.
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Affiliation(s)
- M Lim
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, SA 5005, Australia
| | - H M Brown
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - K L Kind
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, SA 5005, Australia
| | - J Breen
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, SA 5005, Australia
| | - M R Anastasi
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, SA 5005, Australia
| | - L J Ritter
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - E K Tregoweth
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5005, Australia
| | - D T Dinh
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, SA 5005, Australia
| | - J G Thompson
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, SA 5005, Australia
| | - K R Dunning
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, SA 5005, Australia
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Jones C, Olson R, Lim M. Rem sleep deficits persist into adulthood after early life sleep disruption in prairie voles. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hope J, Aqrawe Z, Lim M, Vanholsbeeck F, McDaid A. Increasing signal amplitude in electrical impedance tomography of neural activity using a parallel resistor inductor capacitor (RLC) circuit. J Neural Eng 2019; 16:066041. [PMID: 31536974 DOI: 10.1088/1741-2552/ab462b] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To increase the impedance signal amplitude produced during neural activity using a novel approach of implementing a parallel resistor inductor capacitor (RLC) circuit across the current source used in electrical impedance tomography (EIT) of peripheral nerve. APPROACH The frequency response of the impedance signal was characterized in the range 4-18 kHz, then a frequency range with significant capacitive charge transfer was selected for experiment with the RLC circuit. Design of the RLC circuit was aided by in vitro impedance measurements on nerve and nerve cuff in the range 5 Hz to 50 kHz. MAIN RESULTS The frequency response of the impedance signal across 4-18 kHz showed maximum amplitude at 6-8 kHz, and steady decline in amplitude between 8 and 18 kHz with -6 dB reduction at 14 kHz. The frequency range 17 ± 1 kHz was selected for the RLC experiment. The RLC experiment was performed on four subjects using an RLC circuit designed to produce a resonant frequency of 17 kHz with a bandwidth of 3.6 kHz, and containing a 22 mH inductive element and a 3.45 nF capacitive element with +0.8/- 3.45 nF manual tuning range. With the RLC circuit connected, relative increases in the impedance signal (±3σ noise) of 44% (±15%), 33% (±30%), 37% (±8.6%), and 16% (±19%) were produced. SIGNIFICANCE The increase in impedance signal amplitude at high frequencies, generated by the novel implementation of a parallel RLC circuit across the drive current, improves spatial resolution by increasing the number of parallel drive currents which can be implemented in a frequency division multiplexed (FDM) EIT system, and aids the long term goal of a real-time FDM EIT system by reducing the need for ensemble averaging.
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Affiliation(s)
- J Hope
- The Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand. Dodd Walls Centre for Photonic and Quantum Technologies, Dunedin, New Zealand
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Chen X, Grimm J, Baker B, Son J, Siu C, Redmond K, Bettegowda C, Lim M, Kleinberg L. Fractionated Stereotactic Radiosurgery for Brainstem Metastasis and Brainstem Tolerance. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sloan L, Sen R, Doucet M, Blosser L, Shpitser I, Cheng Z, Katulis L, Wemmer J, Jackson C, Hu C, McNutt T, Grossman S, Holdhoff M, Lim M, Redmond K, Eberhart C, Quon H, Pardoll D, Ganguly S, Kleinberg L. The Immunodynamics of Myeloid-Derived Suppressor Cell and Monocyte Populations in the Peripheral Blood in Patients with Newly Diagnosed Glioblastoma Undergoing Adjuvant Temozolomide and Radiation Therapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Babiker HM, Davis L, Larson K, Placencia C, Swensen C, Tenneti P, Lim M, Cañamar R, Curtis J, Castillo E, Mancuso J, Rensvold D, Martinez S, Macias L, Recio-Boiles A, Chandana SR, Mahadevan D. A Multidisciplinary Evaluation of Barriers to Enrolling Cancer Patients into Early Phase Clinical Trials: Challenges and Patient-centric Recommendations. Expert Opin Investig Drugs 2019; 28:675-686. [PMID: 31327293 DOI: 10.1080/13543784.2019.1646726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Early phase clinical trials are the first clinical research step to bringing new cancer therapeutics to patients. At this stage, a new drug's safety, dosing, and scheduling profiles are established as the main endpoints. However, excellent responses due to biomarker-guided and immune checkpoint trials in early phase have resulted in direct approvals of new anti-cancer drugs. Despite doubling of the success rate of new drug approvals, many barriers exist to expeditiously bring active new drugs to the clinic. Areas covered: This review covers roles of members of the early phase program and the challenges they face in enrolling advanced cancer patients to trials. Practical solutions are provided from the perspective of the investigators, regulatory, investigational pharmacy, research nurses, clinical research coordinators, budgets, contracts, and data management. Expert opinion: We are witnessing a burgeoning era in drug development with rapid approval of efficacious drugs. This is achieved by a strong collaboration between investigators, academic institutions, pharmaceutical sponsors, scientists, Food and Drug Administration (FDA), and community practices. Herein, we discuss some of the challenges faced by early phase clinical trials programs and discuss methods of improvement.
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Affiliation(s)
- Hani M Babiker
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Lisa Davis
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Kristian Larson
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Crystal Placencia
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Connor Swensen
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Pavan Tenneti
- b Department of Medicine, Banner University Medical Center Phoenix , Phoenix , AZ , USA
| | - Melissa Lim
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Ruth Cañamar
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Jacqueline Curtis
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Erica Castillo
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - James Mancuso
- c Department of Immunology, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Diane Rensvold
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Sarah Martinez
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Lora Macias
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Alejandro Recio-Boiles
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Sreenivasa R Chandana
- d Department of Gastrointestinal Medical Oncology, Cancer and Hematology Centers of Western Michigan, Phase I Program, START Midwest , Grand Rapids , MI , USA
| | - Daruka Mahadevan
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
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